The National Library of Medicine has a robust collection of scholarly books and fascinating pamphlets. But what in the world was a “nightmare turtle”? One sunny day last summer, our curatorial team set out with our list from NLM’s online database to uncover the mysteries of this and other items that we hoped to use in an upcoming exhibition.

At the National Building Museum, we explore stories of architecture and design. We hold an extensive collection of building materials and building-related drawings, photography, models, and architectural fragments. However, we usually look elsewhere to augment our exhibitions with items of all sorts from other collections. For example, in our latest exhibition, Architecture of an Asylum: St. Elizabeths 1852-2017, we feature a writing desk, several bricks, a radiator, a watercolor painting, a milk bottle, and some golf clubs. An eclectic array, to be sure. But one that helps us emphasize the role of architecture and landscape in our lives. To play golf at a mental health hospital, one would need a wide expanse of land. To see a milk bottle stamped with the name of the hospital helps visitors understand that there was a creamery and dairy farm on the site. Each of these items is the key to another story.

St. Elizabeths Hospital has been on the same site since the land was purchased by the Federal government in 1852. Since that time, the accumulation of objects and paperwork is such that it is only possible display a small fraction. As the 19th- and 20th-century buildings began to close around the site, archives, libraries, and museums all around Washington, D.C. took possession of some of the vast resources so that future generations could begin to understand the histories at the site—the personal histories, the medical histories, the architectural histories, the administrative histories. It was my job as a curator to find some special pieces that could help our visitors at least start to understand some of these stories, and perhaps be motivated to look into particular subjects further on their own.

At NLM we found a treasure trove. The 1900 by-laws of the Board of Visitors provided us with much information about the paternalistic relationship between the administration and the staff at the hospital, helping us to understand the role of attendants and nurses, many of whom lived on campus for the first century of the hospital’s history. Though we do not delve too deeply into the personal lives of the staff, it is important for our visitors to understand that this vast 350-plus acre campus was home to thousands of both patients and staff members. The by-laws can be lofty in places, describing “dignity of character as is befitting to those engaged in such a noble work for humanity.” But perhaps more interesting is when the document gets down to details: “no profanity and no improper language and use of intoxicating drink of any kind while on duty is strictly prohibited.” It was also interesting to learn that nurses were expected to “see that each patient is given a bath on the day of his admission.” This helps expand our understanding of what it was like for patients to arrive at the hospital. As they moved through the campus during the process of admission, how did the experience bring them into contact with different parts of the landscape and the building? This type of document can help us answer those questions. Some of the tidbits of information within the booklet can bring up other topics. “Keys,” reads the rules, “shall not be entrusted to patients.” Such a rule seems obvious, but must have been included, one presumes, through some buried-by-history infraction.

The by-laws help us illustrate the relationship between patients, the buildings, and the landscape architecture. The document states that nurses and attendants were expected to “take every able-bodied patient out doors for exercise every suitable day.” Of course, this brings up even more questions as to the relationship between patients and the landscaped grounds. It is one thing to learn that outdoor exercise was an expected part of daily life. But we do not necessarily learn who decided which patients were “able-bodied,” or who defined what weather was “suitable” for outdoor activity.

The by-laws also reveal, unsurprisingly, that male attendants and female attendants, though they performed the same work with their patient charges, earned wages at different rates. In the probationary period, for example, men received $18 and women $14 for the same work. Though it was good to learn that “no kicking, striking, shaking or choking of a patient will be permitted under any circumstances.”

But the materials are not all from the early history of the hospital. In fact, some of my favorite items came from the 1960s through the 1980s. In 1964, the Advisory Group on the Future of St. Elizabeths Hospital produced their final report, in which they recommended a “planned, phased, and gradual transfer of St. Elizabeths Hospital from the Department of Health, Education, and Welfare to Washington, D.C.” Since we know that this transfer did not happen for over two more decades (the hospital functions finally transferred to the District in 1987) this is a reminder of the slow-moving government bureaucracy. The report also noted that “unanimity among the Advisory group was not reached in respect to certain of its conclusions,” a stark admission indicating that the question of how to care for people with mental illness has plagued reformers and officials for several centuries—with no end in sight.

To help tell the story of de-institutionalization, in which many large, custodial hospital complexes were transformed into smaller, community health clinics, we decided to use a 1971 document describing the Area D clinic at St. Elizabeths. “Mental illness is no longer shameful,” the booklet claimed optimistically. The clinic presupposed with “high expectations” that outpatients would quickly return to community activities. A 1980 booklet about making Hispanic patients feel more welcome and comfortable at the hospital was illuminating as well, since the directives often related to interior decoration—such as “brightly colored paintings”—and other environmental suggestions. The booklet can be seen as patronizing and misguided, but it also represents an attempt at inclusiveness and demonstrated that the hospital population had changed over time. Including this book in the exhibition allowed us to continue the long-running story of the hospital’s methodologies for differentiating care via several measures including gender and race, which had been a theme throughout the exhibition.

And then there was that nightmare turtle. The National Library of Medicine holds a beautiful collection of mid-19th century magic lantern slides that came from St. Elizabeths. We do not know exactly how these were used, but NLM researchers learned that many mental health practitioners believed that these startling slides, which depict some disturbing images, were part of a therapeutic regimen. In this case, a man lies peacefully in bed until the pulled slide reveals an armadillo sitting on top of a turtle over his head, holding a lobster and a sword. Thomas Kirkbride, whose work on designing mental health hospitals influenced the design of St. Elizabeths, wrote that the slides help alleviate “delusions and morbid feelings, at least for a transitory period.”

Many of these artifacts may pose more questions than they can answer, but that’s part of the process of challenging our visitors. And hopefully any morbid feelings will be transitory.